Speaker Request Form

 The Ronald McDonald House of Durham is a “home away from home” for seriously ill children and their families who are seeking medical treatment at area hospitals. 

 

We would welcome the opportunity to come out and speak to your organization about our house and how you can make a difference!

 

You may request a speaker by contacting Michelle Audette-Bauman, Development Manager

PH: (919.286.9305 ext: 162) Fax: (919.286.7307) or email:speakerrequest@ronaldhousedurham.org 

 

 

Speaker Request Information

 

Date:                                                               Time:                                                  

 

Arrival Time:                                                    Length of Talk:                                    ______

 

Type of Group:                                                Size of Group:                                     

 

Organization Name:                                                                                                    ___________

 

Contact Name:_________________________________________________________________

 

Contact Phone:__________________Contact Email:___________________________________

 

Address:                                                                                                                      ___________

 

Directions:_____________________________________________________________________

 

                                                                                                                                    ____________

 

Special Instructions:                                                                                                    ____________

 

______________________________________________________________________________